<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="UTF-8">
    <title>Title</title>
    <link rel="stylesheet" href="css/register.css">
</head>
<body>
<div class="box">
    <div class="error">
        <img src="img/error.png">
    </div>
    <div class="title">
        <div class="line1"></div>
        <h2>填写资料</h2>
        <div class="line2"></div>

    </div>
    <div class="box2">
        <div>
            <input  class="username" type="text" placeholder="请输入姓名">
        </div>

        <div>
            <input  class="tel" type="text" placeholder="请输入电话">
        </div>
        <div>
            <input  class="verify" type="text" placeholder="请输入图像验证码">
        </div>
        <div>
            <input class="telcode" type="text" placeholder="请输入手机验证码">
            <button id="code">获取验证码</button>
        </div>
        <div>
            <input  class="email" type="text" placeholder="请输入邮箱(选填)">
        </div>
        <div>
            <input  class="other" type="text" placeholder="请输入姓名(选填)">
        </div>
        <div>
            <button  class="send">立即申请</button>
        </div>
        <div class="word">
            申请成功后，我们会跟您联系，有任何疑问，请联系400-118-100
        </div>
    </div>
</div>
</body>
</html>